Elsevier

Ophthalmology

Volume 118, Issue 2, February 2011, Pages 231-235.e1
Ophthalmology

Original article
Surgical Results in the Management of Advanced Primary Congenital Glaucoma in a Rural Pediatric Population

https://doi.org/10.1016/j.ophtha.2010.02.027Get rights and content

Objective

To present the anatomic and functional results of surgical treatment for advanced primary congenital glaucoma (PCG) in a rural setting.

Design

Retrospective, observational case series.

Participants

Forty eyes of 22 consecutive patients diagnosed with PCG and who underwent surgical treatment.

Methods

All eyes underwent surgical treatment for PCG. Type of surgery and postoperative complications were noted. We examined anatomic and functional indices before and after the operation.

Main Outcome Measures

Visual acuity (VA), intraocular pressure (IOP), refractive spherical error, cup-to-disc ratio (CDR), and horizontal corneal diameter (HCD).

Results

Average age at the time of surgery was 3.3 years (range, 0.4–10) and the mean follow-up was 6 months (range, 1–11). 15% showed marked lens dislocation owing to the severe buphthalmos at presentation. Preoperative IOP was 54±2 mmHg, HCD was 15.1±0.3 mm, and CDR (when visible) was 0.8±0.02. Surgical intervention included 31 trabeculotomies, 6 Ahmed Glaucoma Valve implants, 1 goniotomy, and 2 eviscerations. Serious complications were noted in 4 eyes. Final postoperative IOP was 23±2 mmHg (P<0.0001). Patients were significantly more likely to have ambulatory VA (following objects or better) after operation (18% vs 64%; P<0.0001).

Conclusions

Our surgical outcomes in children with advanced PCG demonstrated moderate overall improvement in IOP and modest improvement of VA. Deep deprivation amblyopia, severe disease manifestation at presentation, opaque corneas, and frequent lens dislocation limited the possible success. These data further signify the need for effective, timely screening of children and prompt recognition by health care workers to reduce the rate of avoidable blindness in developing countries.

Financial Disclosure(s)

The authors have no proprietary or commercial interest in any of the materials discussed in this article.

Section snippets

Methods

A retrospective study of all consecutive pediatric patients diagnosed with PCG during 2007 and 2008 in rural southern Ethiopia was conducted at a single center at Hawassa University School of Medicine. The hospital is a referral center for an estimated population of 15 million people; nearly half are children <15 years of age.

This work was part of the ORBIS international and Cyber-Sight project implementing pediatric ophthalmology services in Ethiopia. The work was approved by the regional

Results

Twenty-four consecutive patients (15 male, 9 female) were included in the study. The average age at diagnosis was 3.3±0.5 years. Two cases were lost to follow-up before operative intervention and were not included in further analysis. One pair of monozygotic twins was included in the study groups. Both presented at the age of 6 with bilateral advanced glaucoma (cases 27–30).2 In total, 40 eyes of 22 patients underwent operative care.

Before surgery, all patients underwent a clinical evaluation

Discussion

Glaucoma is a disease of heterogeneous etiologies characterized by elevated IOP that later results in enlarged globe, corneal clouding, and optic atrophy. In some cases, this is followed by lens dislocation and even globe perforation. Primary congenital glaucoma is classified by an isolated, idiopathic developmental anomaly of the anterior chamber angle. Because of its relatively low incidence, leading to decreased awareness, definitive diagnosis can be delayed and subsequent treatment may be

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    • Cited by (0)

    Manuscript no. 2009-1291.

    Financial Disclosure(s): The authors have no proprietary or commercial interest in any of the materials discussed in this article.

    Supported by ORBIS international and Cyber-Sight project.

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